Physicians that have to decide whether an illness is terminal think that “there are not valid and adequate criteria for certifying that an illness is terminal”. This is the conclusion drawn from a pioneer study conducted at the University of Granada, and recently published in the Journal of Clinical and Health Psychology (IJCHP).

For the purpose of this study, 42 health professionals were thoroughly interviewed. Of this group, 21 were physicians and 21 were nurses working with terminally-ill patients in hospitals in the province of Granada. Of the 42 participants, 22 were women and 20 were men with ages between 23 and 52. Of the participants, 17 worked in community health centers, 18 worked in public hospitals, 4 in combined units and 3 worked in private health centers.

This study revealed interesting findings. The answers given by the professionals interviewed revealed that the diagnosing of terminal illness in their daily work differs depending on the type of health centre –primary or specialized care– and the type of professional –physician or nurse.

Use of euphemisms

Concretely, those professionals working in community health centers –both physicians and nurses– use and record “terminal illness” diagnosis to define the clinical condition of their patients. On the other hand, the answers provided by professionals working in public hospitals differ significantly: while nurses use euphemisms or synonyms rather than “terminal illness” diagnosis, physicians use this diagnosis in professional circles and, although they are aware of this circumstance, they avoid using it in their medical reports.

This research conducted at the University of Granada reveals that health professionals have difficulties in certifying terminal illnesses. The question emerges on whether such situation could be preventing palliative care from being provided to a significant number of terminal patients. This means that many terminal patients are being deprived from professional assistance aimed at helping them in facing the end of their lives, and at providing them an acceptable quality of life. Additionally, professionals have a distorted view of the role and purpose of palliative assistance, since they are emotionally conditioned by a diagnosis that –in our society– is associated to a “death sentence”.

This study was co-authored by María Paz García Caro, Francisco Cruz Quintana, Jacqueline Schmidt Río Valle, Antonio Muñoz Vinuesa, Rafael Montoya Juárez, Diego Prados Peña y Miguel C. Botella López from the University of Granada, and Atthanasios Pappous, from the University of Kent, United Kingdom.

Patients with cancer

For a deeper understanding of the difficulties that a diagnosis of “terminal illness” involves and its consequences, health professionals were asked what illnesses get diagnosed as “terminal” and when such diagnosis is disclosed. For most physicians and nurses, “terminal illness” diagnosis is associated only to patients with cancer. However, a significant number of professionals working in community health centers also associate this diagnosis to patients with an advanced stage of some chronic and/or degenerative non-cancerous illness.

As regards terminal diagnosis, it is mostly associated to patients in preagony or agony phase. This opinion is shared by most professionals working both in hospitals and in community health centers.

The study emphasizes the fact that, although the criteria and references for diagnosing a terminal illness –at least in oncological cases– were defined 20 years ago, such diagnosis is still employed in a very restrictive way. Diagnosis of a terminal illness involves a change of treatment, and when patients in terminal stage are not diagnosed as such, they and their families are deprived from the special care and assistance they need.

Similarly, the study remarks the lack of studies on the emotional charge suffered by health professionals treating terminal patients. This study states that this is a key factor when explaining the restrictive use of terminal illness diagnosis, especially in hospitals.

The research conducted at the University of Granada emphasizes the need to improve professional training of care providers in diagnosing a terminal illness, especially in chronic and degenerative illnesses in advanced stages. Additionally, the study remarks the need of further research for determining the scientific parameters on which terminal diagnosis must be based.